Crash Course?! Thoughts on RN education

elkpark · Oct 28, 2007

My point is, if med surg experience after graduation is recommended by so many to strengthen skills, then clearly something is a bit off with the nursing education programs in this country.

I don't disagree with you there -- I've argued for years that nursing education is one of the (several) areas in nursing in which, IMHO, we've thrown the baby out with the bathwater. Back when there was much less that nurses needed to know and much less accountability involved, we turned out new grads who knew much more about nursing and were much better prepared to practice as entry level nurses. As the stakes get higher and higher from year to year (decade to decade), we appear to be teaching people less and less in nursing school. I'm a diploma grad who has been full-time faculty in both ADN and BSN nursing programs (obviously, I've continued my education beyond my original diploma), and, when I think back on how much I knew and how prepared I was to begin practice as an entry-level RN when I graduated, compared to new graduates of either ADN or BSN programs today, I'm truly shocked. And I'm not talking about the Dark Ages, either; I graduated in the mid-'80s (although I realize that seems like the mists of antiquity to a lot of folks on this board ... :lol2: )

I'm not sure exactly when or where we went so far astray in nursing education, but I believe that we have definitely gone off the rails ...

smk1, LPN · Oct 28, 2007

Honestly the theory in all of the different areas is good info to have (psych, family, peds etc...) We could probably cut L&D clinicals and psych clinicals from the program though and replace it with more med surg. L&D is so highly specialized and most new grads won't go straight there anyway that it really isn't necessary to have clinicals there. Also because of legal issues we couldn't do lady partsl checks, give any narcs or touch pit etc... (whith good reason) but still we didn't do as much. It was interesting, but probably the time could have been better spent on a more general floor gaining more experience in the basics. Same with psych. The theory and lecture on these subjects should stay in, but the clinical experience maybe should be reserved for the final preceptorship clinicals. I't is hard because I have leaned something from each unit, but the basic skill set that is expected of new nurses is easier to learn and master on a more general floor.

lindarn · Oct 28, 2007

I don't disagree with you there -- I've argued for years that nursing education is one of the (several) areas in nursing in which, IMHO, we've thrown the baby out with the bathwater. Back when there was much less that nurses needed to know and much less accountability involved, we turned out new grads who knew much more about nursing and were much better prepared to practice as entry level nurses. As the stakes get higher and higher from year to year (decade to decade), we appear to be teaching people less and less in nursing school. I'm a diploma grad who has been full-time faculty in both ADN and BSN nursing programs (obviously, I've continued my education beyond my original diploma), and, when I think back on how much I knew and how prepared I was to begin practice as an entry-level RN when I graduated, compared to new graduates of either ADN or BSN programs today, I'm truly shocked. And I'm not talking about the Dark Ages, either; I graduated in the mid-'80s (although I realize that seems like the mists of antiquity to a lot of folks on this board ... )
I'm not sure exactly when or where we went so far astray in nursing education, but I believe that we have definitely gone off the rails ...

We are not throwing the baby out with the bath water. We are following the successful trends of other health care professionals, who decided to provide more classroom knowledge, and less technical skills in the scholastic setting, and added a mandatory one year internship to teach the technical skills that are needed to practice. The same as doctors. They moved past a Bachelor's degree as enty into practice, and have gone to a Doctorate, and Masters Level entry into practice. They have not suffered for it, and out earn us by at least 50%. They also have the prestige that goes along with a graduate level of education.

Nursing, on the other hand, continues to increase the knowledge that RNs need to know to successfully care for patients in the high tech 21st Century environment, but continue to support Diploma and ADN programs, and continue with the LPN/LVN educational tract.And fight any and every attempt to increase the educational entry into practice.

What is wrong with this picture? Can we not emulate other health care professionals who have successfully moved into a higher level of education, without losing applicants to their career fields in the process? Insanity is expecting a better result, etc, while following the same course of action. They have not suffered because it takes longer to finish the program, and indeed they have florished.

And no, lawyers do not graduate from law school and try cases in front of the US Supreme Court the next day. They work for a law firm in the law specialty they desire to practice in, and after a couple of years of learning in that environment, they usually move on the another law firm as a junior parnter, or start their own law firm.

And we know doctors have a one year internship and two year residency before they can practice on their own. So what is so wrong that we are graduating nurses who have a sound educational background and are ready to learn how to successfully put that knowledge into practice, and work as nurses? Even doctors usually have a one year internship in medicine, before they branch out into the specialty that they desire to practice in. That is why there is nothing wrong with nurses working 1-2 years in med surg before they go into ICU/CCU, ER ,etc. The med surg knowledge forms the necessary framework to build on the go to a more advanced specialty.

Lindarn, RN, BSN, CCRN

Spokane, Washington

Ausculapius · Oct 29, 2007

This is all the more reason that nursing needs to abandon the ADN and Diploma nursing programs, and go to a BSN as entry into practice.
Lindarn, RN, BSN, CCRN
Spokane, Washington

It's interesting that you should mention this. I've been seriously considering going directly into a BSN program when I graduate. Everyone I've talked to, including instructors, have advised against it. Apparently there is some thought that clinical skills will be lost in the two years completing the BSN. Honestly at this point I don't have much to forget.

fronkey bean · Oct 29, 2007

We are not throwing the baby out with the bath water. We are following the successful trends of other health care professionals, who decided to provide more classroom knowledge, and less technical skills in the scholastic setting, and added a mandatory one year internship to teach the technical skills that are needed to practice. The same as doctors. They moved past a Bachelor's degree as enty into practice, and have gone to a Doctorate, and Masters Level entry into practice. They have not suffered for it, and out earn us by at least 50%. They also have the prestige that goes along with a graduate level of education.
Nursing, on the other hand, continues to increase the knowledge that RNs need to know to successfully care for patients in the high tech 21st Century environment, but continue to support Diploma and ADN programs, and continue with the LPN/LVN educational tract.And fight any and every attempt to increase the educational entry into practice.
What is wrong with this picture? Can we not emulate other health care professionals who have successfully moved into a higher level of education, without losing applicants to their career fields in the process? Insanity is expecting a better result, etc, while following the same course of action. They have not suffered because it takes longer to finish the program, and indeed they have florished.
And no, lawyers do not graduate from law school and try cases in front of the US Supreme Court the next day. They work for a law firm in the law specialty they desire to practice in, and after a couple of years of learning in that environment, they usually move on the another law firm as a junior parnter, or start their own law firm.
And we know doctors have a one year internship and two year residency before they can practice on their own. So what is so wrong that we are graduating nurses who have a sound educational background and are ready to learn how to successfully put that knowledge into practice, and work as nurses? Even doctors usually have a one year internship in medicine, before they branch out into the specialty that they desire to practice in. That is why there is nothing wrong with nurses working 1-2 years in med surg before they go into ICU/CCU, ER ,etc. The med surg knowledge forms the necessary framework to build on the go to a more advanced specialty.
Lindarn, RN, BSN, CCRN
Spokane, Washington

Trouble is that the health industry needs more RN's than MD's and as we are already one of the biggest expenditures they will not be eager to see BSN become entry level for practice. And personally. I've worked w/ some very good ADN's and a couple of good diploma nurses and would hate to see opportunities to further their education be lost for those who can't manage starting out w/ a four year degree (like me). Somehow nursing has to create a stairstep model where the more education you get the more areas and responsibilities you are qualified for. This would enable those who can't afford to get a BSN the chance to break into nursing while ensuring areas that require more knowledge and practice will have higher degree nurses w/ a correspondingly higher pay.

suzy253, RN · Oct 29, 2007

There is not enough time in the two year programs, and not enough clinical time in the BSN programs, to adequately prepare student nurses to be effectiveley work in the "real" work of nursing.

True, not enough time in the 2 year programs and not enough clinical time in the BSN programs. But the 3-year diploma programs, from which I graduated from truly prepare you extremely well for the real nursing world. In fact, I now have students from a "SNAP" ADN program and I'm shocked at how little they know and they will be graduating in less than a year.

elkpark · Oct 30, 2007

So what is so wrong that we are graduating nurses who have a sound educational background and are ready to learn how to successfully put that knowledge into practice, and work as nurses?

But that's my concern -- I don't see us "graduating nurses who have a sound educational background;" if I did see it, I wouldn't be kvetching every time someone starts a thread on this topic. I'm amazed at how little both ADN and BSN (new) graduates know these days, and I'm talking about knowledge, not skills (I realize there's no point any more in even talking about skills). Until I resigned last spring, I taught in a well-respected state university BSN program where I taught psych lecture and clinical to senior level nursing students who were getting ready to graduate, and I found in clinical that they didn't know even the most basic stuff about common medications or common conditions like HTN or DM; it was very scary to think that they were getting ready to graduate and start working. I've worked with nursing students from a variety of schools over the last decade or so, both ADN and BSN programs, and have observed the same.

It saddens me deeply that I have been forced to conclude in recent years that, when it comes to undergraduate nursing education, "the emperor has no clothes."

And I have been listening to people turn up their noses at the "lowly" diploma programs all these years, and suggest that everything in nursing would be better if we could only get rid of those last few pesky diploma programs that make all the rest of us look bad :uhoh21:, but I will continue to tell anyone who will listen that I got a much better nursing education, including in-depth knowledge (not just skills), critical thinking, professionalism, ethics/legal issues, and management/leadership, than students have gotten in any of the several ADN or BSN programs I've had experience with since then. Granted, there were good, mediocre, and poor diploma programs, just as there is a wide range of quality in ADN and BSN programs, and maybe I just happened to have stumbled into the only outstanding diploma program in the country (but I doubt that :) ).

I realize I'm in a very small minority here and what I think doesn't really matter, but I have a v. hard time just sitting by quietly when people start talking about how much better nursing education is now than back in the "bad old days." I'm certainly not "anti-" formal education, or even requiring a BSN for entry in practice -- I just don't think much of the way BSN programs are set up today. Somehow, we're missing the mark (IMHO, of course).

jjjoy, LPN · Oct 30, 2007

It saddens me deeply that I have been forced to conclude in recent years that, when it comes to undergraduate nursing education, "the emperor has no clothes."
- I just don't think much of the way BSN programs are set up today. Somehow, we're missing the mark (IMHO, of course).

I agree with you. I can see both the pros and cons of BSN as entry to practice but that's not the point here. The point here is the content of RN education and if there might not be some other approaches. BSN or ADN, I think the approach of RN education could use some reflection. My original concern in starting this thread was that I felt that my own RN (BSN) education, which demanded lots of time and effort, didn't seem to teach much, if that makes any sense. Too much of our testing focused on preparing for the NCLEX (almost all tests were written in NCLEX style), having to write each and every care plan from scratch (it's a good exercise and nurses should be able to do this, but it was overkill in our program) and covering all the content (through long homework reading assignments and rushed, straight from the book lectures) required by NLN or other accrediting bodies as opposed to preparing for clinical practice... and I don't just mean opportunities to practice tasks, but the nuts and bolts of symptom assessment, management and underlying pathophys... as opposed to lists of s/s, treatments, etc for lists of diseases.

Kiringat · Oct 30, 2007

Honestly, I think my program (ADN) is a joke. There is way too much information crammed into the space of a couple of weeks, that there's almost no point. We're having tons of information crammed into our heads, but no time to get comfortable with it or integrate it into anything meaningful.

Our entire advanced med/surg course is six weeks long. One day of lecture a week.

For example: we will be spending the next two weeks going over cardiac stuff. Five book chapters (about 600 pages) crammed into two six hour lectures. We're covering reading ECGs (advanced!!) the same day we're going over EVERY class of cardiac medication PLUS heart failure and MIs. The second day of lecture, we finish up all the cardiac stuff, then start in on GU disorders.

Then we get to take a comprehensive, 75 question cardiac exam that historically, has an 80% failure rate. Every person in the class is at the edge of a nervous breakdown or massive drinking binge. I understand the need to have a comprehensive knowledge base, but this is just crazy. We're not learning anything but how to assess for stress ulcers, because we all have them.

And I agree with the previous post about preparing for the NCLEX. I've lost count of how many times an instructor has told us to remember something "because its on the NCLEX." I am soooo sick of hearing that! What about stuff that I need to know to take care of a living, breathing (hopefully) patient someday?!?!? If I need to know exactly what is on the NCLEX, I'll fork over the money and take a prep course. I'm not going to be inserting an IV into a test or something anytime soon, but I would really love to really understand why everyone starts going crazy when a patient's telemetry starts spiking in strange ways!

twotrees2 · Feb 3, 2008

To me, nursing school often felt like a series of crash courses, one in each specialty area. Dozens of disease processes and conditions were covered each lecture, with no time for questions, discussion or digestion.
I can understand the motivation to try to cover so much. RNs currently are hired for nursing jobs as varied as those in NICU, CCU, L&D, invasive procedures, OR, LTC, and more in addition to the stereotypical bedside med/surg nursing position. But is it possible that there's just currently too much material to cover to be adequately prepared for all the potential roles an RN may be asked to fill?
Why have every nursing student cover 1000 pages of L&D nursing (or ICU nursing, pediatric nursing, etc) when most of them will never work L&D (or fill-in-the-blank)? It's great to introduce the students to the broad spectrum of nursing possibilities in case they want to pursue them, but reviewing a 1000-page book of it is a bit of overkill for an "introduction."
And why not focus on symptom assessment and management as opposed structuring nursing texts around 1000 different diseases and conditions? Why have every nursing student study retinal detachment, cervical traction, laryngeal cancer, hydronephrosis....? Cover the biggies such as diabetes, CHF, stroke, etc... and leave the rest for specialty training that's perhaps post-registration. So after one gets their RN, they can take specialty coursework, such as orthopedics, neuro, oncology etc. And it wouldn't take longer because RN training would be much shorter if all students didn't have to cover all specialties as extensively as they do now. And if a nurse wanted to switch specialties, they could take a cram course in just that one area, which would be useful for both the nurse and the employer.
I understand that both nurses and hospitals have benefitted from nursese being able to float between units, but the reality is that after years working in one area, most will forget what they learned about those other areas anyway. As it is, there aren't too many formal ways for a nurse to bone up on their skills and knowledge when changing to a different area. Yes, self-study is important! But for safety reasons, is it really enough to only count on a nurse's training from years prior and their own self assessment of their preparedness to start into a new area?
It seems as if the schools (and BON that set minimum requirements) want nurses to be able to say to just about anything they come across "I studied that in school!" That's a great ideal, but to me, reading 1-2 pages out of thousands of pages of reading doesn't count for much. Having the name of this or that disease sound familiar and having some idea of what body system it affects doesn't really help me take care of a patient. I'll still have to go and look up the condition because I won't remember the details. Meanwhile, because we had to cover so much material in class, we didn't have time to ask questions or discuss things in lecture. We didn't address real world nursing situations - like how we might deal with 6 or more acute care patients or how we might deal with 20+ LTC patients.
Just thoughts! I'm sure there are those who see things differently and have had different experiences. I'm curious to hear any responses!

i was alwasy told it is so we "know where to go to look things up IF we should ever need it - makes sense to me - what doesnt make sense to me is back then we had GOOD orientations - months of being followed as an intern and months more followed as a grad nurse- nowadays these nurses get thier license in a few days and they get a day or 2 ( if that in a nursing home often it isnt even that) of orientation and are expected to perform and those of us who would love to mentor them are so overloaded it is almaost impossible. just my opinion.

twotrees2 · Feb 3, 2008

Woody - I wasn't complaining about the amount of work in nursing school. It just seemed like for the amount of time I had to put into it, I came out of it knowing at little about a lot of things but not enough to really do anything with it. For all of the work it was, I didn't feel I'd mastered anything... except perhaps writing care plans - which no one needs to write as practicing nurses. Yes, you work from them, but you don't have to come up with them from scratch as we did in school. I also learned how to pass the NCLEX.
I expect that there is much to learn on the job, that school won't teach me everything, but I also expect to learn a lot in two years of intensive study (jr/sr year BSN program). We covered a lot of ground but I really didn't feel that I *really learned* much. Maybe that's just an indication of my own strengths, weaknesses and preferences, as I felt the learned the most in my pre-reqs (microbio, chemistry) and auxiliary courses (epidemiology, statistics, psychology).
Some information was repeated again and again through the nursing courses, across the spectrum of of conditions, such as preventing and assessing for DVT and pulmonary embolism, preventing and assessing for skin breakdown, etc.... those things, very important nursing responsibilities, are what stuck. But which medications go exactly with which diseases? What are the prognoses for different diagnoses? What specific symptoms should I be expecting to see? I'd have to look it up same as if it were a disease or condition I'd never formally studied in school. So why spend all of that valuable time studying a multitude of conditions on might come across instead of spending more time in clinical, actually seeing the diseases and conditions?
Sure, I studied a little bit about traction, but if I were to work with a patient in traction, unless I happened to have previous clinical experience with that, I'm going to have to ask for help and look up the details of that specific variety of traction to know exactly what nursing care is required and to understand the specifics of whatever type of traction is being used. If I were to care for patient with AML, I'd have to look up the drugs and information on the disease in order to properly care for the patient; I couldn't just rely on what I'd studied in school.
Going on a tangent here.....
I'm just curious here... wondering what your nursing school experience was like and how it compares to nursing programs today. I don't want to assume one way or another. Did you guys have the same two inch thick texts? Surgical nursing, maternity nursing, etc? Were you assigned hundreds of pages a reading each week in each text? Did you have the same ridiculously vague nursing exam questions? Were lectures essentially a rehash of the readings with no time for questions or elaboration? (Since the texts were essentially already summaries of disease processes and treatments, lectures couldn't really summarize it any more than that). If so, were you satisfied with that?
Some programs today do have strong clinical components but from what I've read here, it seems many do not... often due to liability concerns, I'd imagine, as well as the lack of strong clinical instructors. Students care for no more than 2 patients for much of the time and have to wait around for the instructor to do tasks. Students also often have a hard time coming across enough opportunities to practice skills for all the students. They might have only done one foley catheter and set up a chest tube set once during their entire education.

id like ti say tyhat it depends on where you work if you need to write the careplans or noot- the gals where i work ( i am agancy so am not yet allowed - however as i work only there all the time lol the gals are trying to get me "okd " to do them as they got me "okd " to do the mesh acuitys- i am hoping they dont let me LOLOL) anyhow they have to write thier careplans from scratch ( they have set up templats to use so they can nab from them but they had to write them from the start - this is new for them and they arent happy either lol)

also yes big books, lots of reading and lectures and no i wasnt happpy. i learn better from hands on and that is where i got MOST of my knowledge from experience - that is just me - many people are good at book stuffs. as i said in another post- it saddens me for nurses today cause if you are like me and dont do well book wise you may as well not even try cause they do not give you experience they throw you out to fend for yorselves IMMEDIATELY and that is just not right even though around here anyhow it is the norm.

scooterRN52 · Feb 3, 2008

I was an LPN for two years before becomming an RN and I went to a hosital school for LPN. THE LPN program taught me more than the ADN program in college. The BSN programs today are not as good as the diploma programs of the past. They are getting 6months to a year orientation to work as a new RN. WE never had that, but we had a better education.